pericardiocentesis

Pericardial injuries can be caused by pleural-pericardial laceration and hernia-pericardial laceration. The former can cause pericardial, left or right pleural-pericardial tear due to blunt impact from the anterior direction; it can also cause myocardial contusion. -pericardial laceration often coexists with diaphragmatic rupture. Simple pericardial laceration, if the mouth is small, can produce blood pericardial or acute cardiac tamponade; if the breach is larger, the most critical situation is the occurrence of cardiac dislocation and intrusion into the pleural cavity, called pericardium. In the case of a pericardial laceration, the abdominal organs can also enter the pericardial cavity, the latter being called the pericardium. Dislocated heart, or abdominal organs can cause severe circulatory dysfunction if incarcerated at the rupture. Treatment of diseases: pericardial effusion Indication Pericardial puncture is often used to determine the nature of the effusion (exudation or leakage) and pathogens, and can be injected into the pericardium. When there is a tamponade, the puncture can be puncture to relieve the symptoms. Pericardial puncture is suitable for: 1. A large number of pericardial effusions have symptoms of cardiac tamponade, puncture drainage to relieve compression symptoms. 2. Extract the pericardial effusion to assist in diagnosis and determine the cause. 3. Pericardial drug delivery treatment. Contraindications 1. Hemorrhagic disease, severe thrombocytopenia and those who are receiving anticoagulation are relatively contraindicated. 2. Those who intend to puncture the site with infection or bacteremia or sepsis. 3. Patients who do not work well with the surgical procedure. Preoperative preparation 1. Drugs, 2% lidocaine and various rescue drugs. 2. Instruments, 5 ml syringe, 50 ml syringe, 22G trocar, chest piercing bag. If continuous pericardial drainage is required, it needs to be prepared: puncture needle, guide wire, sharp knife, skin expander, sheath tube, pigtail pericardial drainage tube, tee, heparin cap, gauze, etc. 3. Heart monitor, defibrillator. 4. Echocardiography before surgery to help determine the location, needle direction and depth. The distance from the puncture site to the pericardium is measured to determine the depth of the needle. 5. Open the venous access. 6. Explain the purpose and method of surgery to patients and their families to relieve tension. 7. Sign the informed consent form for surgery. Surgical procedure Pericardial puncture (1) The patient usually takes a sitting position or a semi-recumbent position, exposing the front chest and upper abdomen. Carefully pick out the heart and voice, choose the puncture point. Choose a location with a large amount of fluid, but try to make the puncture site as close as possible to the nearest part, while avoiding damage to surrounding organs. The direction of the puncture can be determined by echocardiography if necessary. Commonly used sites are the left sternal border, the right sternal border, the apex and the xiphoid. It is most commonly used under the xiphoid and apex. (2) Disinfect the local skin, cover the disinfection hole towel, and perform local anesthesia from the skin to the pericardial wall layer at the puncture site. (3) Clamp the rubber tube connected to the puncture needle, and insert the needle into the selected and localized area. The specific method is: 1 under the xiphoid puncture: at the angle between the xiphoid and the left rib Needle, puncture needle and the abdominal wall at an angle of 30 ° ~ 45 °, upward, backward and slightly to the left into the posterior part of the pericardial cavity; 2 apical puncture: in the left 5th intercostal or 6th intercostal dullness within 2cm The needle is inserted into the pericardial cavity along the upper edge of the rib to the back and slightly toward the median line; 3 Ultrasound positioning puncture: the needle is inserted along the site, direction and depth determined by the ultrasound. (4) Slowly enter the needle. When the resistance of the needle suddenly disappears, it indicates that the needle has entered the pericardial cavity. When the heart beats and hits the needle tip, the needle should be slightly retracted to avoid scratching the heart and fixing the needle body. The depth, still no liquid outflow can be retracted to the skin, slightly change the puncture direction and try again. (5) After entering the pericardial cavity, the assistant connects the syringe to the rubber tube, releases the clamp, and slowly pumps the liquid. When the needle is full, before removing the needle, the hemostatic forceps should be used to clamp the rubber tube. Air enters. Record the amount of liquid collected and leave the specimen for inspection. If a trocar is used, after confirming that the pericardial effusion has flowed out, the cannula is withdrawn while feeding the cannula. Fix the cannula, connect the syringe, and slowly draw the fluid. Record the amount of liquid collected and leave the specimen for inspection. (6) After the pumping is completed, pull out the needle or sleeve, cover the sterile gauze, press for several minutes, and fix it with tape. 2. Continuous drainage (1) ECG and blood pressure monitoring. (2) Take the semi-recumbent position 30° and expose the front chest and upper abdomen. (3) Disinfect the skin under the xiphoid process, cover the disinfection hole towel, and perform local anesthesia from the skin to the pericardial wall layer at the puncture site. (4) Generally, the needle is inserted at the angle between the xiphoid and the left rib arch, and the puncture needle and the abdominal wall are at an angle of 30° to 45°, and enter the posterior and posterior part of the pericardium cavity upward and backward and slightly to the left side; Determine the direction and position of the needle. (5) feeding the guide wire along the puncture needle, withdrawing the needle, and cutting the skin with a sharp knife; the skin and subcutaneous tissue of the puncture site can be expanded by the skin expander, the pericardial drainage tube is sent along the guide wire, the guide wire is withdrawn, and the drainage effect is observed, if necessary, Adjust the position of the catheter properly to ensure smooth flow. (6) The sealing needle is fixed, the drainage bag is connected, and the drainage is slow. (7) Cover the sterile gauze, press for a few minutes, and fix with a tape.